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Incidence of postoperative nosocomial endophthalmitis:
results of an eight-year prospective surveillance programme in a university hospital in France
Maggie Le Bourhis-Zaimi, Hélène Marini, Julie Gueudry, Emile Calenda, Thomas Vermeulin, Noelle Frebourg, Marc Muraine, Veronique Merle
To cite this version:
Maggie Le Bourhis-Zaimi, Hélène Marini, Julie Gueudry, Emile Calenda, Thomas Vermeulin, et al..
Incidence of postoperative nosocomial endophthalmitis: results of an eight-year prospective surveil- lance programme in a university hospital in France. Journal of Hospital Infection, WB Saunders, 2017, 96 (4), pp.399-400. �10.1016/j.jhin.2017.05.008�. �hal-02316794�
Accepted Manuscript
Incidence of postoperative nosocomial endophthalmitis: results of an 8-year prospective surveillance program in a university hospital in France
Maggie Le Bourhis-Zaimi, Hélène Marini, M.D., Julie Gueudry, M.D., Emile Calenda, M.D., Thomas Vermeulin, M.D., Noelle Frébourg, M.D., Ph.D., Marc Muraine, M.D., Ph.D., Véronique Merle, M.D., Ph.D.
PII: S0195-6701(17)30278-5 DOI: 10.1016/j.jhin.2017.05.008 Reference: YJHIN 5104
To appear in: Journal of Hospital Infection
Received Date: 6 April 2017 Accepted Date: 12 May 2017
Please cite this article as: Le Bourhis-Zaimi M, Marini H, Gueudry J, Calenda E, Vermeulin T, Frébourg N, Muraine M, Merle V, Incidence of postoperative nosocomial endophthalmitis: results of an 8-year prospective surveillance program in a university hospital in France, Journal of Hospital Infection (2017), doi: 10.1016/j.jhin.2017.05.008.
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Incidence of postoperative nosocomial endophthalmitis: results of an 8-year prospective surveillance program in a university hospital in France.
Maggie Le Bourhis-Zaimia,e, Hélène Marini, M.D.a,e, Julie Gueudry, M.D.b, Emile Calenda, M.D.c, Thomas Vermeulin, M.D.a,e, Noelle Frébourg, M.D., Ph.D. d, Marc Muraine, M.D., Ph.D.b, Véronique Merle, M.D., Ph.D.a,e.
a Department of Infection Control, Rouen University Hospital, Rouen, France b Department of Ophthalmology, Rouen University Hospital, Rouen, France
c Department of Anesthesiology, Rouen University Hospital, Rouen, and EA3830, IRIB, Normandie Université, Rouen, France.
d Department of Microbiology, Rouen University Hospital, Rouen, France e Groupe "Dynamiques et Evènements des Soins et des Parcours"
Corresponding author:
Maggie Le Bourhis-Zaimi
1 Rue de Germont, 76031 Rouen, France (33) 6 16 95 00 90
zaimi.mag@gmail.com
Key words: Postoperative endophthalmitis
,
cataract surgery,
surveillance, surgical prophylaxisM AN US CR IP T
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2 Sir,
Endophthalmitis is a major complication of eye surgery1. Infection control measures include epidemiological surveillance of nosocomial infections, are a component of hospital infection prevention2. In France, the 2010 guidelines3 (SFAR) recommended antibiotic prophylaxis with oral levofloxacin, and indicate that intracameral cefuroxime injection could reduce the incidence of postoperative endophthalmitis but with a low level of evidence. With
continuous improvement in surgical techniques and infection control measures, there is a need to assess current rates of postoperative endophthalmitis in routine practice.
The department of ophthalmology at our tertiary care university hospital in France performs 2000 surgical procedures each year. Patients receive a preoperative shower and face
cleaning with povidone-iodine scrub the day before and the morning of surgery. In the operating room, after topical administration of tetracaine 1%, povidone-iodine 5% is applied to the skin around the eye and to the ocular surface and instilled in the fornix, before
surgery. Until 2010, levofloxacin antibiotic prophylaxis was administered to patients with diabetes, long-term corticosteroid-therapy, or immunosuppressive therapy, and to patients undergoing secondary implantation, or revision surgery with an intraocular period of less than 1 month. Since 2010, levofloxacin antibiotic prophylaxis is also administered for procedures involving implantation of a device, excepting for cataract surgery. In 2011, intracameral injection of cefuroxime was introduced for cataract surgery, except for patients with allergies to cephalosporins and penicillin. The aim of our present study was to calculate the incidence of postoperative endophthalmitis through a prospective surveillance
programme during an 8-year period between 2007 and 2014.
Prospective surveillance of postoperative endophthalmitis has been performed at our university hospital since November 2006. All intraocular surgical procedures, except reoperations for endophthalmitis, are included in the surveillance programme. Possible cases of endophthalmitis are identified via both systematic review of bacteriological samples and weekly meetings with eye surgery nurses and with the operating room team. Possible cases of infection are systematically presented to surgeons for validation. Diagnosis of postoperative endophthalmitis is based on the definitions issued by the Center for Disease Control (CDC)4 for nosocomial infections. All cases of endophthalmitis occurring within 30 days of intraocular surgery (or within 1 year for implants) are taken into account5. The number of surgical procedures is obtained via the hospital information system.
A total of 15865 intraocular surgeries (7425 cataract surgery procedures) were performed between 1st January 2007 and 31st December 2014, in 8245 men and 7620 women, median age of 67.7 years (0-102.4). Postoperative endophthalmitis was diagnosed in eight eyes of eight different patients, yielding an incidence of 0.05% (0.02-0.10: 95% CI). Cataract surgery procedures (with or without intraocular lens) accounted for seven of the eight cases of endophthalmitis yielding an incidence of 0.09% (0.04-0.19: 95% CI). The incidence of
postoperative endophthalmitis after cataract surgery decreased from 0.32% in 2007 to 0% in 2014. The characteristics of infected patients are summarized in Table 1.
The incidence of postoperative endophthalmitis observed in our survey was low and
decreased throughout the study period. We were not able to detect a significant difference
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3 in the incidence of postoperative endophthalmitis after the introduction of intracameral antibiotic prophylaxis despite a reduction by half of the incidence of endophthalmitis during the period with cefuroxime versus the period without-cefuroxime. This may be explained by the small number of cases of endophthalmitis. The rate of endophthalmitis decreased in our study just after the surveillance programme was set up. This phenomenon has previously been described (under the name of Hawthorne effect) in some instances after the
introduction of a nosocomial infection surveillance programme in hospitals6, although not in a constant way7. The fact that the incidence of endophthalmitis remained stable between 2008 and 2014 after the initial decrease may be explained by the low baseline incidence of postoperative endophthalmitis at our university hospital. A study by Wykoff et al. with a similar population and long-term surveillance showed a significant decrease in rates in the 2002-2009 period only when compared with a reference period 20 years previously, suggesting that long-term follow-up is required to highlight a decrease in low rates of postoperative endophthalmitis8.
The limitations of our study are that it was a single centre study and that in this real life survey we did not collect patients’ characteristics. The strengths of our study are the large size of the cohort; the active search method for collecting data on postoperative infections combining several sources of information; the validation of endophthalmitis by both the infection control team and the surgeon; the low risk of missed diagnoses since ours is the only hospital in the region caring for patients with endophthalmitis;, and the fact that the same method was used consistently throughout the study period.
In conclusion, our study, conducted in a large cohort, provides an up-to-date incidence rate for postoperative endophthalmitis, which could be used as a reference.
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ACKNOWLEDGEMENTS
The authors thank Marie-Agnès Perrier for assistance with data collection and Tristan Petel for his contribution to the long-term prospective surveillance programme and for his invaluable assistance in data collection. We are also grateful to Nikki Sabourin-Gibbs, Rouen University Hospital, for her help in editing the manuscript.
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Table 1
Demographics and culture data for patients with postoperative endophthalmitis Patient no. Age
(years)
Sex Year of diagnosis
Initial surgery Latency (days)
Bacteria
1 75 F 2007 Cataract 6 S epidermidis
2 56 M 2007 Cataract 3 S epidermidis
3 79 F 2007 Cataract 6 S epidermidis
4 66 F 2008 Cataract 35 MRSA
5 82 F 2009 Cataract 4 S epidermidis
6 62 M 2012 Cataract 2 Streptococcus spp.
7 61 M 2013 Cataract 5 S pneumoniae
8 54 M 2013 Trabeculectomy 6 NI
S epidermidis, Staphylococcus epidermidis; MRSA, Methicillin-resistant Staphylococcus aureus; S pneumoniae, Streptococcus pneumoniae; NI, not isolated.
